Most cases of macular degeneration fall under dry AMD, where minute yellow deposits called drusen form beneath the retina. About 85% of these patients see either reduced vision loss or maintain it over time; many can even still read.

10% of individuals develop abnormal blood vessels which form and leak fluid underneath the retina. Once treated by laser photocoagulation, anti-VEGF injections now offer more efficient solutions.

Anti-VEGF Injections

Anti-vascular endothelial growth factor (anti-VEGF) drugs are currently the standard of care for treating neovascular age-related macular degeneration (nAMD), and have proven successful at slowing progression of macular atrophy and decreasing blinding strokes associated with wet AMD. Unfortunately, due to their invasive nature this treatment requires regular appointments and administration of medication; additionally pain in the eye has been identified as one major barrier to patient compliance and satisfaction with this form of therapy; yet research into pain management strategies during intravitreal injections remains limited.

New research published in Graefe’s Archive for Clinical and Experimental Ophthalmology suggests that protein Apolipoprotein B100 could counter the negative impact of anti-VEGF treatment on macular atrophy for wet AMD patients. Apolipoprotein B100 is a natural component of the drusen material found under retinas of all patients suffering from either wet or dry AMD and has been shown to promote early changes such as vascular remodeling, atrophy, and choroidal neovascularization.

Anti-VEGF injections have become the go-to treatment option for wet neovascular age-related macular Degeneration as well as other vision-threating conditions like diabetic retinopathy, retinal vein occlusions, and proliferative diabetic retinopathy (PDR). These medications, taken via injection into the eye, reduce leakage of blood vessels that causes fluid build-up in retina. There are three FDA-approved treatments: Avastin, Lucentis and Eylea. Faricimab from Genentech and sold under the brand name Vabysmo has been shown to be comparable in vision improvement with current standard agents, and may reduce injection frequency over time due to its longer half-life. Shorter intervals between treatments could allow patients to be weaned off these injections at the end of one year of therapy without experiencing any visual loss – an important consideration given that long-term effectiveness of such treatments has yet to be fully established.

Fluorescein Angiography

Fluorescein angiography involves injecting an eye with a special dye that travels through your blood vessels. A camera then captures images (angiograms) to help your retina specialist examine the structure and circulation of your eyeball, helping them diagnose macular degeneration as well as determine whether you have dry or wet forms of this disease. This test helps establish whether you suffer from dry macular degeneration.

Macular degeneration occurs in two forms. Dry AMD occurs as the macula thins with age and forms tiny clumps of protein called drusen under the retina, gradually leading to gradual vision loss without leading to blindness. Wet AMD occurs when abnormal blood vessels grow under the retina that leak fluid into scar tissue that occurs behind it; wet AMD can result in rapid vision loss more severely than dry AMD.

Around 80% of those diagnosed with AMD have the dry form, which does not lead to blindness and can be managed with diet, vitamins and mineral supplementation, and regular dilated eye exams. Ten percent have wet AMD, which can quickly lead to vision loss characterized by abnormal blood vessels that grow under the retina that leak fluid into it from outside, leading to eye scarring that accelerates vision loss and causes rapid vision loss.

For this procedure, fluorescent dye is injected through a small plastic tube that opens in your arm. Once in your eye, this fluorescent dye travels back through its path towards the back and circulates throughout choroid and retina, where retina specialists use photographs and videos to document its flow and pattern as it fills or leaks through any areas that fill or leak. While photographic film was once needed to develop these tests quickly can now be reviewed instantly by retina specialists.

At our practice, our retina specialists have years of experience using this non-invasive procedure safely and painlessly. Possible side effects may include temporary numbness in the arm where the plastic tube was inserted and some temporary nausea or vomiting that usually goes away quickly; for severe symptoms an antiemetic medication such as IV atropine may be used before proceeding with this procedure.

Optical Coherence Tomography

Optical Coherence Tomography (OCT) is a noninvasive diagnostic tool that uses light waves to image eye structures noninvasively and produce cross-sectional images of retina at micron scale resolution. OCT was co-invented by David Huang from OHSU Casey Eye Institute physician-scientist David Huang in 2004, revolutionizing how many eye diseases are diagnosed, monitored and treated. OCT serves as an indispensable diagnostic tool in caring for conditions such as dry age-related macular degeneration, glaucoma and diabetic eye disease among many others.

OHSU Casey Eye Institute physicians have pioneered the use of optical coherence tomography (OCT) for various eye conditions, with optical coherence tomography angiography (OCT-A) serving as one of the most reliable ways to detect fluid development within retina. OCT-A allows rapid flow-based imaging of retinal and choroidal vasculature, enabling key insights into understanding why fluid accumulates beneath the retina causing vision loss due to diseases like Wet macular degeneration or other eye conditions.

Wet Macular Degeneration may be less prevalent, but its progression can be much quicker. This form occurs when abnormal blood vessels form under the retina and leak fluid into the macula, damaging its cells.

Anti-VEGF therapy for Wet AMD is used to prevent further damage and enhance vision. These anti-VEGF drugs interfere with chemicals that encourage new blood vessel growth, stopping these from growing or leaking; intravitreal injection is then performed using a fine needle; popular medications include Avastin, Lucentis and Eylea.

Laser treatment may be suggested for cases of Wet AMD in certain situations. This involves the use of painless laser light to destroy abnormal, leaking blood vessels; usually done at a doctor’s office. Although laser treatment may help delay further loss of vision and slow its progression, it cannot restore lost vision already experienced.

If you have Dry macular degeneration, it is recommended that you continue seeing your doctor regularly and carefully monitor symptoms. For those diagnosed with Wet AMD, however, it is essential that they visit their physician quickly in order to identify and treat any new abnormal blood vessels before they cause permanent vision loss.

Laser Surgery

As dry AMD progresses, abnormal blood vessels may grow alongside it resulting in wet macular degeneration – leading to rapid loss of central vision if left untreated. Wet macular degeneration occurs when new blood vessels form beneath the retina in the area of macula that leak blood or fluid and create blurry or distorted vision, blurring central vision further.

We now have treatments available for wet macular degeneration. These options include anti-VEGF injections to decrease abnormal blood vessel formation and stem the leakage of fluid, or laser procedures called photodynamic therapy that use light beams into your eye to activate verteporfin in an anti-VEGF injection injected in your arm, followed by shining bright lights into your eye – light activates this drug which “sticks” to newly formed blood vessels, ultimately dismantling them and leading to slower vision decline – with no pain involved or downtime for recovery afterwards! The process requires no downtime either!

As macular degeneration affects your vision over time, regular eye examinations at our office are essential to its progression. Our experienced optometrist can identify any changes and suggest treatments to halt further loss of sight; in addition we may recommend low vision aids like magnifying glasses, tape-recorded books and magazines, taped playing cards, enlarged playing cards, talking clocks and scales that may help adapting with loss of central vision.

At present, we are exploring additional treatments for wet macular degeneration including the combination of drugs and laser surgery known as LUCENTIS (discussed above). This treatment combines drugs that bind to abnormal blood vessels with laser surgery that destroys them; up to 40% of patients treated may see their vision improve following this approach; it is the only known therapy capable of slowing progression earlier on than others.